But mothers continue to die - for lack of magnesium sulphate -- a safe, effective and inexpensive drug, says EngenderHealth, an international reproductive health organization.
The drug could prevent deadly complications arising from pre-eclampsia, a condition which sees rapid elevation of blood pressure.
Pre-eclampsia, when left untreated, can lead to seizures (eclampsia), kidney and liver damage, and ultimately, death. Approximately 63,000 pregnant women die every year because of eclampsia and severe pre-eclampsia, which are also associated with a higher risk of newborn death. Of course most of these deaths take place in the developing world.
Based on the latest scientific evidence, the World Health Organization (WHO) has recommended magnesium sulfate as the most effective, safe, and low-cost medication to treat eclampsia and pre-eclampsia. While magnesium sulfate has been the standard treatment in the developed world for the past 20 years, less-effective and riskier medications (such as diazepam and phenytoin) are still widely used for these conditions in most developing countries. This is yet another example of the enormous disparity in the quality of maternal health care between industrialized and poor nations, notes EngenderHealth.
Earlier this year, in response to this issue, the NGO and the University of Oxford brought together leading scientists, advocates, researchers, and representatives of the WHO, UNICEF, United Nations agencies, and national ministries of health from around the world to identify country-specific barriers to the availability and use of the drug, as well as factors that facilitate its utilization in settings where magnesium sulfate is not the treatment of choice within public health systems.
The gathering of global public health experts identified the following as the primary barriers to the use of magnesium sulfate:
Lack of National Priority and Guidelines. In countries like Nigeria, Uganda, and Pakistan, guidelines mandating magnesium sulfate use do not exist, and only about half of the world's countries include magnesium sulfate on their national list of "essential drugs."
Lack of Education and Training. Many clinicians remain unfamiliar with the safety and effectiveness of magnesium sulfate and continue to rely on other, less-effective and riskier drugs.
Supply Shortage. Relative to other health conditions, pre-eclampsia and eclampsia affect a small population. In addition, magnesium sulfate is relatively inexpensive. In combination, these factors leave little or no incentive for pharmaceutical companies to make magnesium sulfate more widely available.
Based on these conclusions, EngenderHealth and the University of Oxford have developed a "Call to Action" that calls on policy makers and ministers of health to make pre-eclampsia and eclampsia a higher priority and to set national guidelines for treatment and care based on WHO guidelines. It also urges decision makers and international and national health organizations and agencies to help make magnesium sulfate more available and affordable, in part by empowering local clinicians with education and training.
"Today, magnesium sulphate is still not available in the hospitals of many countries, nor is it on the countries' essential drug lists," the group said.